SAMHSA Terminates Best Practices Registry in Favor of Emerging 'Policy Lab'

NYAPRS Note: SAMHSA’s recent decision to freeze and ultimately eliminate its National Registry of Evidence-Based Programs and Practices (NREPP) received a good deal of public attention last week.

As background: NREPP was created in 1997 to provide “an evidence-based repository and review system” that was “designed to help people learn more about available evidence-based programs and practices and determine which of these may best meet their needs.” Its website (https://nrepp.samhsa.gov/landing.aspx) reportedly “lists 453 programs in behavioral health — aimed at everything from addiction and parenting to HIV prevention, teen depression, and suicide-hotline training.” In order to be listed on the registry, programs had to undergo a review process overseen by an outside SAMHSA contractor. Programs could be self-nominated for review or identified by the administration for review.

Last week, HHS Assistant Secretary for Mental Health and Substance Use Dr. Elizabeth McCance-Katz explained that SAMHSA was terminating NREPP out of her concern that the practices identified by the NRREP lacked sufficient scientific evidence and that too few of those practices addressed the most urgent needs of those with substance use and serious mental health conditions (see below).

Instead, SAMHSA will be turning to a new National Mental Health and Substance Use Policy Laboratory that was authorized by last year’s 21st Century Cures Act and that “promotes innovation and the dissemination and adoption of evidence-based practices and service delivery models related to mental health and substance use, including through the evaluation of models that would benefit from further development and through expanding, replicating, or scaling evidence-based programs and policies.

The Policy Lab will also play a role in awarding grants to state and local governments, educational institutions and nonprofits to develop evidence-based interventions, she said. The lab will also identify programs or activities “that are duplicative and are not evidence-based, effective or efficient.” Last week, Christopher M. Jones, PharmD, M.P.H., was appointed at the program’s first Director.

NYAPRS welcomes an approach that prioritizes the identification of proven practices that address the most urgent needs, especially those that demonstrate their effectiveness in reducing homelessness, incarceration, hospitalizations, poverty, isolation and suicide. In that spirit, it is critical that SAMHSA ensure a substantive investment be made in the evaluation of some of our most promising practices in these areas, notably peer support and psychiatric rehabilitation, that have been sufficiently studied and replicated to date.

Come hear Dr. McCance-Katz share details about the new directions federal behavioral health policy will take in the coming years at NYAPRS’ Annual Executive Seminar, “New Strategies and Partnerships to Support the Most Challenged New Yorkers: The Way Forward” on April 19-20 in Albany. Watch for full program details in the coming weeks. 
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Statement of Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use regarding the National Registry of Evidence-based Programs and Practices and SAMHSA’s new approach to implementation of evidence-based practices (EBPs)Thursday, January 11, 2018

SAMHSA and HHS are committed to advancing the use of science, in the form of data and evidence-based policies, programs and practices, to improve the lives of Americans living with substance use disorders and mental illness and of their families.

People throughout the United States are dying every day from substance use disorders and from serious mental illnesses. The situation regarding opioid addiction and serious mental illness is urgent, and we must attend to the needs of the American people. SAMHSA remains committed to promoting effective treatment options for the people we serve, because we know people can recover when they receive appropriate services.

SAMHSA has used the National Registry of Evidence-based Programs and Practices (NREPP) since 1997. For the majority of its existence, NREPP vetted practices and programs submitted by outside developers – resulting in a skewed presentation of evidence-based interventions, which did not address the spectrum of needs of those living with serious mental illness and substance use disorders. These needs include screening, evaluation, diagnosis, treatment, psychotherapies, psychosocial supports and recovery services in the community.

The program as currently configured often produces few to no results, when such common search terms as “medication-assisted treatment” or illnesses such as ”schizophrenia” are entered. There is a complete lack of a linkage between all of the EBPs that are necessary to provide effective care and treatment to those living with mental and substance use disorders, as well. If someone with limited knowledge about various mental and substance use disorders were to go to the NREPP website, they could come away thinking that there are virtually no EBPs for opioid use disorder and other major mental disorders – which is completely untrue.

They would have to try to discern which of the listed practices might be useful, but could not rely on the grading for the listed interventions; neither would there be any way for them to know which interventions were more effective than others.

We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system. From my limited review – I have not looked at every listed program or practice – I see EBPs that are entirely irrelevant to some disorders, “evidence” based on review of as few as a single publication that might be quite old and, too often, evidence review from someone’s dissertation.

This is a poor approach to the determination of EBPs. As I mentioned, NREPP has mainly reviewed submissions from “developers” in the field. By definition, these are not EBPs because they are limited to the work of a single person or group. This is a biased, self-selected series of interventions further hampered by a poor search-term system. Americans living with these serious illnesses deserve better, and SAMHSA can now provide that necessary guidance to communities.

We are now moving to EBP implementation efforts through targeted technical assistance and training that makes use of local and national experts and will that assist programs with actually implementing services that will be essential to getting Americans living with these disorders the care and treatment and recovery services that they need.

These services are designed to provide EBPs appropriate to the communities seeking assistance, and the services will cover the spectrum of individual and community needs including prevention interventions, treatment and community recovery services.

We must do this now. We must not waste time continuing a program that has had since 1997 to show its effectiveness.

But yet we know that the majority of behavioral health programs still do not use EBPs: one indicator being the lack of medication-assisted treatment, the accepted, life-saving standard of care for opioid use disorder, in specialty substance use disorder programs nationwide.

SAMHSA will use its technical assistance and training resources, its expert resources, the resources of our sister agencies at the Department of Health and Human Services, and national stakeholders who are consulted for EBPs to inform American communities and to get Americans living with these disorders the resources that they deserve.

https://www.samhsa.gov/newsroom/press-announcements/201801110330